MO Discretionary Funding Fiscal Year 2023

Compass Health, Inc. d/b/a Compass Health Network is in the process of applying for a grant offered from the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration entitled FY2023 Cooperative Agreements for 988 Suicide and Crisis Lifeline Center Follow-Up Programs (Short Title: Crisis Center Follow-Up). The three-year grant program is intended to expand efforts among Lifeline crisis centers to support individuals post-contact to provide continued support and linkages to decrease suicide risk. Ur project title, Compass Health 988 Follow Up Program, is requesting funding from SAMHSA to enhance current efforts being developed and delivered within a four-county service region in Missouri (Cass, Henry, Hickory, and Vernon Counties). The service region is predominantly Caucasian, with 91% of the service region comprising this race, with 11.75% of the population lacking access to insurance and more than 12% of the population enrolled in state Medicaid. The number served will depend on the number of regional calls made to the 988 system for this region, but we anticipate the following for those in which we will engage in clinical programming post contact with 988: YR1: 75; YR2: 100; YR3: 125. Additional individuals in crisis may be engaged and served beyond this anticipated count. With this program, it is the goal of SAMHSA and our system to significantly enhance continuity of care with engagement of hospitals, behavioral health organizations and services, as well as 911/PSAP’s (Public Safety Answering Points), MCO and police, to safeguard and ultimately improve the well-being of individuals who are at risk of suicide. Compass Health plans to support the required personnel (Project Director and Project Evaluator) as well as hire 2.00 FTE 911 Diversion Coordinators and 2.00 FTE Peer Specialists to assist in the program development and implementation of all coordination activities and follow-up care coordination. This will include direct work with local PSAP providers that directly interface with the 988 system. In collaboration with the Missouri Behavioral Health Council and selected 988/911 community partners, we are proposing to implement four regional Centers of Excellence with 988 providers and 911 PSAP providers to support engagement, collaboration, and interoperability. The Centers of Excellence in each of the four listed counties will implement 911/988 interoperability practices in their respective regions and utilize lessons learned to devise a strategy to implement and support 911/988 interoperability statewide across Missouri. Core activities of each Center of Excellence will include the following: 1) needs and opportunity assessment; 2) coordination and engagement activities – including engagement with community health care providers in each community to support follow-up care post contact; 3) implementation of 911/988 interoperability; 4) development of 911/988 training resources and tools to strengthen the existing system and for replicability; 5) sustainability planning to ensure continuity of funding and care coordination activities. The experiences that each of these centers in establishing interoperability will be utilized to create a blueprint for outreach, education, training and standards that can be leveraged by other 988 call centers, PSAP’s and CCBHC’s throughout Missouri. All required activities and objectives, as set forth by SAMHSA, will be addressed and tracked.

Since its national launch in July of 2022, the 988 Suicide & Crisis Lifeline has played a vital role in providing rapid access to crisis services for individuals experiencing mental health, suicide, or substance use crises. In Missouri, the Department of Mental Health (referred to throughout this application as Grantee), alongside behavioral health providers and community partners, has been working diligently to establish a comprehensive “no-wrong-door” integrated crisis response system. This collaborative effort aims to prevent tragedies, save lives, and optimize resource utilization. Missouri’s vision is to build an evidence-based care continuum to deliver high-quality community based crisis services statewide with the 988 Suicide and Crisis Lifeline at its core. Since implementation, Missouri has witnessed a steady and continuous rise in the demand for 988 services. From July 2022 to April 2023, Missouri’s 988 Centers received 41,779 calls, 5,756 texts, and 9,195 chats. Notably, call volume alone increased by 65% from April 2022 to 2023. In the short time since the introduction of statewide 988 text and chat routing, text volume has risen by 41% and chat volume by 126% between November 2022 and April 2023. Conservative contact volume estimates indicate that the number of people to be served annually is approximately 52,800 and the number of people to be served throughout the lifetime of this project is 158,400. Considering the rising demand and projected needs for SFY24 and beyond, Grantee is proactively assessing and monitoring the necessary funding and support required to sustain a 90% or higher in-state call answer rate and improve state response to 988 texts and chats. As a grant recipient, Grantee will aim to leverage the funding received from state appropriations as well as the achievements of the 988 State and Territory Capacity Cooperative Agreement to strengthen 988 Center response and enhance and integrate crisis response services available for all Missourians in crisis. Upon completion of grant activities, Grantee will have achieved the following goals: 1. Support coordination across Missouri’s crisis continuum to facilitate seamless connection to appropriate care and improve access to community-based crisis services. 2. Strengthen 988 implementation fidelity through the establishment of quality assurance practices and improvements in data collection efforts. 3. Increase awareness and education of the 988 Suicide & Crisis Lifeline and crisis services through a comprehensive statewide public awareness campaign. 4. Enhance state 988 response for high-risk and underserved populations through expansion of text and chat workforce capacity and specialized training for crisis specialists. By accomplishing these goals, Grantee, in collaboration with 988 Centers and dedicated partners, will build upon the foundation established during the initial year of 988 implementation. Ultimately, the aim is to ensure that all Missourians, especially high-risk populations, have equitable access to vital services when in crisis or needing support. Grantee is committed to supporting the expansion of life-saving interventions and fostering the overall well-being of the state’s population. The efforts undertaken through this grant will have a substantial impact on strengthening Missouri’s crisis system of care.

Summary: Behavioral Health Network will expand the Bridges to Care and Recovery program to supplement existing infrastructure within predominantly Black faith communities. Training will be provided to congregants, community members, and pastors to reinforce decreased stigma and increased awareness of and sensitivity to the needs of individuals with or at risk for mental illness or suicide. Populations to be served: The BCR Expansion will train members of faith communities, pastors, and others living or working close to the faith communities of focus in North St. Louis City and North St. Louis County, predominantly Black communities. Strategies/interventions: The BCR Expansion will focus on training youth and congregants in a variety of mental health awareness training programs, including two evidence-based programs, Mental Health First Aid and Question, Persuade, Refer. Other trainings will include Sharing Hope, a mental wellness training program designed for Black communities, and pastoral curriculum will be designed, piloted, and implemented with pastors to help them more effectively build mental health stigma reduction and mental wellness resources into the liturgy. Project goals and measurable objectives: The project will train 160 individuals annually, for a total of 480 individuals during the project period, with many receiving multiple trainings. Goal 1: Increase awareness of and sensitivity to the needs of individuals with or at risk for mental illness and/or suicide in Black communities in North St. Louis City and County. [Needs Addressed – high rates of mental illness and substance abuse and associated deaths; low rates of engagement with mental health professionals; disproportionately high rates of negative social determinants of health] Obj. 1.1: 192 out of 240 (80%) youth and adults completing QPR training will demonstrate increased knowledge of suicide prevention over the three-year project period. Obj. 1.2: 48 out of 60 (80%) Wellness Champion pastors attending QPR for Pastors will demonstrate increased knowledge of suicide prevention during the three-year project period. Obj. 1.3: 144 out of 180 (80%) adults completing trauma-informed communities training will demonstrate increased knowledge of trauma and its impacts during the three-year project period. Obj. 1.4: 96 out of 120 (80%) adults completing MHFA will demonstrate an understanding of the signs and symptoms of mental health and substance use challenges during the three-year project period. Obj. 1.5: 96 out of 120 (80%) adults completing Sharing Hope will be better able to recognize signs and symptoms of mental health conditions. Obj. 1.6: Increase the number of individuals referred annually through BCR programming from 191 in 2022 to 230 in 2026, a 20% increase in the number of people referred for support. Obj. 1.7: Create a curriculum, associated materials, pre and post-tests, and a training manual to teach pastors to integrate behavioral health stigma reduction into the liturgy.

The proposed Healing to Recovery project demonstrates an innovative collaboration between two established entities: Behavioral Health Network of Greater St. Louis and Haven Recovery House, with the overarching intent of establishing recuperative care models in recovery housing settings for homeless and at risk of homelessness young adults and men, women, and all genders and orientations ages 18-65, located within the St. Louis Metropolitan Statistical Area. The POF will primarily emanate from the City of St. Louis, population 296,958, which is a unique independent governance within 65 square miles, and the adjacent northern sector of St. Louis County, comprised of 26 highly diverse separate municipalities, population 322,003, occupants of which are historically and persistently marginalized, with poverty rates ranging as high as 46%. Significantly high incidences and hotspots saturated by gang activity, violent crime, poverty, and disinvestment in both the City of St. Louis and northern St. Louis County are well documented, ranking among the highest in the United States, with both areas located in the footprint of a Federal Promise Zone. According to Continuum of Care (CoC) data, the 2022 HUD Point in Time census of homelessness in St. Louis increased by 34% in the 5 years from 2018, and by 60% during 2023. Healing to Recovery will focus on the following strategies and interventions serving 30 persons in year 1, 60 in year 2, 60 in year 3, 60 in year 4 and 30 in year 5 for a total of 240: outreach and engagement, with a focus on marginalized populations; screening, mental health and substance use disorders services, case management including enrollment in mainstream benefits and linkage to stable housing, recovery support services, and referral / follow-up; the development of a steering committee; collaboration with the 988 system; and stakeholder mapping. Project goals and objectives are as follows: Goal 1: Increase the number of medically fragile, SUD/COD, homeless individuals with an emphasis on African Americans served, engaged, and retained in services throughout the project. Objective 1.1: Up to 240 clients will be provided comprehensive recuperative care services in a recovery housing setting, mental health and co-occurring disorder services over the 5-year project. Objective 1.2: 100% of clients in the program will be connected to BH or SUD treatment. Objective 1.3: 100% of clients in the program will receive recovery support services and meet with a peer support specialist. Objective 1.4: 60% of clients enrolled in the project will be retained in treatment or recovery services for 6 months. Objective 1.5: 100% of clients needing interpretation / translation will have access to appropriate services throughout the project. Goal 2: Improve behavioral and health outcomes for 70% of clients enrolled in the project. Objective 2.1: 70% of clients enrolled in the project will report a reduction in SUD/COD symptoms over 6 mos. Objective 2.2: 70% of clients in SUD/COD treatment services will experience a reduction in drug and alcohol use / misuse over 6 months. Objective 2.3: 100% of clients who are not covered will be offered assistance with enrolling eligible participants or their families including health coverage, food stamps and social security programs, as applicable, throughout the 5-year project. Objective 2.4: 70% of clients will improve social connections at 6-month follow up. Objective 2.5: 50% of clients will be in sustainable, permanent housing by the end of the project.

Burrell Behavioral Health (Burrell) requests $2,000,000 to improve and enhance implementation of our existing system wide Zero Suicide Model and partner with Preferred Family Healthcare (PFH) to improve their suicide response as joint venture health system. Chosen subpopulations of focus will include men over 18 years and the LGBTQIA+ population across the geographic catchment area. Burrell's internal data indicates possible barriers to men and minorities being enrolled on the Supportive Care Pathway implemented in 2022; studies show this is due to lack of understanding about to access professional services, a lack of education around self-help and coping mechanisms and stigma around mental illness. This project is expected to serve 400 individuals annually for a total of 2,000 individuals throughout the life of the project. Burrell's Zero Suicide Cooperative will use the following strategies to implement the required activities: 1) Utilize current processes, procedures and historical knowledge to improve upon the existing seven elements of the Zero Suicide Framework; 2) Utilize evidence based informed communication and safe messaging throughout Burrell and PFH to build Zero Suicide culture and buy-in; 3) Work alongside SAMHSA in a cooperative agreement to make changes in our joint health system. The project objectives include: 1) Utilize the organizational and workforce survey to improve Burrell's Zero Suicide Framework taking systematic steps across our organization to create a culture that no longer finds suicide acceptable; 2) Improve Burrell's Supportive Care Pathway so that all individuals at risk of suicide are engaged using a suicide care management plan; 3) Develop and implement a training program, that includes EBP's for the clinical workforce who are in frequent contact with individuals who are at risk or suicidal; 4) Improve overall engagement of clients who are on the Supportive Care Pathway while working with Suicide Prevention Liaisons. As Missouri's second-largest Certified Community Behavioral Health Organization, Burrell serves three distinct geographic catchment areas encompassing 18 counties in southwest, central and western Missouri. The project GCA population exceeds 1,500,000, or over one in four Missourians. 100% of the counties are designated mental health and primary care professional shortage areas and 72% are designated Medically Underserved Areas and Communities. Congressional districts benefitting are Missouri's districts MO-004-MO-007. The top 10 languages spoken in this area include: English, Spanish, German, Chinese, African Languages, Vietnamese, Other Germanic Languages, French, Russian and Tagalog.

Burrell Behavioral Health (Burrell) requests $4,000,000 over four years for Project CCBHC-IA to transform Burrell's community behavioral health system by enhancing and improving the established CCBHO. Project CCBHC-IA will serve Burrell's 18-county geographic catchment area (GCA) in Missouri to improve access to community-based mental health services and substance us disorder treatment and support, including 24/7 crisis services, to anyone in the GCA regardless of their ability to pay or place of residence. CCBHC-IA's population of focus (POF) is any individual with a mental or substance abuse disorder who seeks care, including those with a serious mental illness (SMI), substance use disorder (SUD), including opioid use disorder, children and adolescents with a serious emotional disturbance (SED), individuals with a co-occurring disorder (COD), and individuals experiencing a mental health or substance use related crisis. Studies show nearly 53% of adults in Missouri with a mental illness have unmet needs for specialized treatment and 57% of children with a Major Depressive Episode (MDE) never receive treatment; screening, assessment, and treatment needs are high (MHA, 2022). A 2021 Kaiser Family Foundation study found that overdose death rates have increased in Missouri from 16.4 per 100,000 to 36.5 per 100,000 - more than a 125% increase. Since 2010 Missouri's suicide rates have been consistently higher than the United States and in 2020 suicide was the third leading cause of death for youth 10-17 and adults 25-34 (CDC, WISQARS 2020). Burrell recognizes significant gaps in the GCA and will address them through this grant by modernizing aspects of the current mental health system, enhancing service delivery models, and improving the total health - physical, mental and social - of clients. Project CCBHC-IA will serve at least 400 clients annually (1,600 total). Burrell's Project CCBHC-IA will use the following strategies to implement the required activities: 1) Utilize current process, procedure and historical knowledge to improve upon the existing CCBHC model in place; 2) Continuously evaluate and assess effectiveness of programming to refine strategies and ensure delivery of high-quality care services and; 3) Maintain adherence to CCBHC Certification Criteria throughout the project period with oversight provided by Burrell's Accreditation Department. The Project Objectives include: 1) Use the CCBHC model to improve access to comprehensive community-based mental health, SMI, SUD, SED and COD care and services; 2) Deliver customized health, human and social services and supports using a wrap-around service model; 3) Provide top quality care and services utilizing evidence-based practices with fidelity on a consistent basis; and 4) Deliver care and services resulting in high levels of client satisfaction (e.g. - customer satisfaction).

Project name: System of Care St. Louis (SOC-STL) Populations to be served: The proposed SOC-STL expansion will serve youth aged 21 and under with a serious emotional disturbance (SED) or who have early signs and symptoms of Serious Mental Illness, who disproportionately experience homelessness or are at risk of experiencing homelessness in St. Louis City and St. Louis County. Youth of color and LGBTQI youth experience significant disparities in homelessness, therefore the project focuses on these groups. Strategies/interventions: Direct services will use a combination of clinical and non-clinical interventions. Clinical interventions will include trauma-focused cognitive behavioral therapy and other therapeutic modalities. Non-clinical interventions will include peer support and youth leadership/mentoring. Training and technical assistance partners are led by people of color and/or LGBTQI people with expertise in serving these populations and training other organizations to improve services for target populations. Other infrastructure improvements include integrating a referral and resource guide created by and for LGBTQI people looking for mental health services. All strategies and interventions are culturally appropriate for the target populations and employ evidence-based, evidence-informed, and culturally responsive practices. Project goals and measurable objectives: The project will serve 95 individuals in year one and 190 in each of years two through four for a total of 665 individuals served during the project period. An abbreviated list of project goals and objectives follow. Goal 1: Strengthen and enhance current infrastructure to connect youth to family support and culturally appropriate mental health services. Obj. 1.1 Within the first four months, complete a needs assessment to identify gaps in service delivery for youth with/at risk of SED disproportionately experiencing homelessness/at risk of homelessness with a focus on LGBTQI youth and youth of color. Goal 2: Provide evidence-based and culturally appropriate mental health services to youth, under 21, with or at-risk of SED/SMI and their families that are disproportionately experiencing homelessness or at risk of homelessness with a focus on LGBTQI youth and youth of color. Obj. 2.1 Provide Family Support Partner services to 125 unduplicated youth per year. Goal 3: Significantly mitigate youth's mental health-related symptoms by posttreatment. Obj. 3.1 70% of youth who receive TF-CBT will manifest significantly lower PTSD, internalizing, and externalizing symptoms by posttreatment. Goal 4: Increase the knowledge of and skills about effective strategies to decrease health disparities and stigma related to LGBTQI and Black youth seeking behavioral health services of SOC-STL direct service providers. Obj. 4.1 Annually, provide 4 trainings and 4 hours of technical assistance to 4 mental health service providers on the values, guiding principles, and practices required to effectively serve LGBTQI youth. Goal 5: Provide outreach and engagement to increase access to family support and evidence-based and culturally appropriate mental health services. Obj. 5.1 Annually, receive 200 referrals from SOC Linkage and Referral Platform/ Youth Connection Helpline, SQSH's Peer Support Warmline, courts, and community partners.